穴位按壓對大腸直腸癌病人手術後腸蠕動之成效

The Effectiveness of Acupressure on Postoperative Bowel Movement in Patients with Colorectal Cancer

10.6880/TJON.202306_23(1).03

林幸雅(Hsing-Ya Lin)；黃靜宜(Chin-Yi Huang)；黃頌儼(Sung-Yen Hung)；吳美雯(Mei-Wen Wu)

大腸直腸癌 ； 手術後 ； 穴位按壓 ； 腸蠕動 ； colorectal cancer ； postoperative ； acupressure ； bowel movement

腫瘤護理雜誌

23卷1期（2023 / 06 / 01）

25 - 35

繁體中文;英文

大腸直腸癌治療方式以手術為主，因麻醉、疼痛、延遲下床會造成手術後腸蠕動不佳、腹脹，影響病人進食及傷口復原，導致住院天數延長，增加醫療照護成本。本研究目的在探討穴位按壓對大腸直腸癌病人手術後腸蠕動之成效，採類實驗法研究設計，以時間區隔方式將病人分配至實驗組（n = 36）及對照組（n = 37）。對照組採常規護理，實驗組由研究護理師於術後第一天至第五天，每日一次予雙下肢足三里（ST36）、上巨虛（ST37）及下巨虛（ST39）共六個穴位各按壓2分鐘，共12分鐘，以探討穴位按壓對腸蠕動恢復、手術後首次排氣時間及腹脹程度之成效。研究結果顯示大腸直腸癌病人手術後接受穴位按壓者，在手術後首次排氣時間較未接受穴位按壓者短（p = .046）、自覺腹脹程度也顯著減輕（p = .034）。建議將穴位按壓納入大腸直腸癌病人手術後照護措施，並給予大腸直腸癌病人手術後護理指導單張，讓病人在住院期間可以運用穴位按壓促進腸蠕動恢復，出院返家後也能自行按壓穴位，以預防手術後腸阻塞的併發症。

Surgical intervention is the main treatment method for colorectal cancer. The anesthesia, surgical pain, and the delayed ambulation cause poor bowel movements and abdominal distension after surgery, which affect the patient's diet and wound healing, prolong the length of hospital stay and increase the cost of medical care. The purpose of this study is to investigate the effect of post-op acupressure on bowel peristalsis in patients with colorectal cancer. This study was designed using a quasi-experimental method, and the patients were allocated to the experimental group (n = 36) and the control group (n = 37) in a time-segmented manner. The control group received routine nursing care, while the experimental group received the acupressure therapy from the research nurse on the six acupoints of Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39) on both the lower extremities, one acupoint for 2 minutes each for a total of 12 minutes for once a day from the first day to the fifth day after the operation. This is to explore the effect of acupressure on the recovery of bowel movement, the time of the first flatus after surgery, and the degree of abdominal distension. The results of the study showed significant differences in reducing the time of the first flatus after surgery (p = .046) and decreasing of patient perceived abdominal distension degree (p = .034) in the patients who received the acupressure after surgery. Based on the results of this study, it is suggested that acupressure therapy should be included in the postoperative care measures for patients with colorectal cancer, such as the post-operative nursing guidance leaflets, so that the patients can use acupressure to improve the recovery of bowel movements during hospitalization. After being discharged from the hospital and returning home, they can also continue to press on the acupoints by themselves to prevent complications of postoperative intestinal obstruction.

1. 曾怡菱,許春宏,曾惠珍(2015)。應用足三里穴位按摩改善結腸切除術後病人腹脹感之護理經驗。護理雜誌，62(5)，96-102。
   連結：
2. Chao, H. L.,Miao, S. J.,Liu, P. F.,Lee, H. H.,Chen, Y. M.,Yao, C. T.,Chou, H. L.(2013).The beneficalial effect of ST-36(Zusanli) acupres-sure on postoperative gastrointestinal function in patients with colorectal cancer.Oncolo-gy Nursing Forum,40(2),61-68.
3. Hsiung, W. T.,Chang, Y. C.,Yeh, M. L.,Chang, Y. H.(2015).Acupressure improves the post-operative comfort of gastric cancer patients: A randomised controlled trial.Complementary Therapies in Medicine,23(3),339-346.
4. Hu, W.,Ying, X.,Sun, J.,Fan, B.,Guo, R.(2021).Self-administered acupressure for chronic severe functional constipation: A study protocol for a randomized controlled trial.Medicine,100(25)
5. Liu, Y.,May, B. H.,Zhang, A. L.,Guo, X.,Lu, C.,Xue, C. C.,Zhang, H.(2018).Acupuncture and related therapies for treatment of postop-erative ileus in colorectal cancer: A systematic review and meta-analysis of randomized con-trolled trials.Evidence-Based Complementary and Alternative Medicine,2018
6. Liu, Y.,Tang, W. P.,Gong, S.,Chan, C. W.(2017).A systematic review and meta-analysis of acupressure for postoperative gastrointestinal symptoms among abdominal surgery patients.The American Journal of Chinese Medicine,45(06),1127-1145.
7. 林昭庚,李德茂,孫茂峰,許昇峰,陳必誠(2009).新編彩圖針灸學.知音.
8. 林聖芬,唐婉如,張玉坤,馬素華(2011)。穴位按壓對老人便秘之成效。護理暨健康照護研究，7(3)，175-187。
9. 馬惠文,張曼玲,林綽娟(2007)。以系統性文獻回顧檢視穴位按壓在護理實務的應用。護理雜誌，54(4)，35-44。
10. 張建新(2019)。足三里艾灸促進腹腔鏡下闌尾切除術後腸蠕動恢復的時效性研究。世界最新醫學信息文摘，91，188-189。
11. 趙明玲,陳綠蓉(2010)。穴位按壓對植物人便秘之成效初探：隨機分派研究。中西整合醫學雜誌，12(2)，11-20。
12. 衛生福利部國民健康署（2022，12月29日更新）．109年癌症登記報告． 取自https://www.hpa.gov.tw/EngPages/EngTopicList.aspx?idx=0&nodeid=269。
13. 賴鎮源(2013).圖解經絡穴位按摩速查全書.含章行文出版集團.
14. 羅堅女,金國軍(2020)。足三里穴位按摩對腹部手術後腸功能恢復的療效觀察。中華中醫藥雜誌，35(3)，1611-1612。